The Dan Plan: The Importance of Practice to the Novice Resident

Dan’s story and the story most young surgeons have both start with the same simple premise: the more you practice something, the better you get.

Dan's plan was beautiful in its simplicity.He would marshal every resource available to him — time, youth, money, prayer, anything — and focus it on one goal: to become an elite golfer. So he quit his job, set up a proto-Kickstarter with a catchy name (The Dan Plan), and hit the links. He had science as his caddy: Malcolm Gladwell's Outliers had just dropped and its exaltation of the so-called 10,000-hour rule — the amount of practice supposedly required to achieve expertise in a particular discipline — had captured the public's attention. Everyone could see that hard work was the new black, but Dan was determined to follow the idea to its logical conclusion.

Dan's aggressive, single-minded pursuit and impressive knack for marketing won him a glorious 15 minutes of fame. His website, where he blogged regularly and kept an exhaustive statistical record of his progress, became something of a sensation. He was showcased on magazine covers and national news programs. And by all accounts, his gains were impressive. His methodical approach, which was overseen by accomplished golf coaches and experts in performance science, had him drilling as much as 4 to 5 hours per day. He didn't play an 18-hole round until nearly 2 years into the project, but once he did, his scores improved swiftly and steadily. Dan's march toward golf stardom began to take on an air of inevitability.

More than 6000 practice hours later, however, Dan's plan is mired in the deep rough. A back injury has limited his practice time, he lost his complementary membership at a fancy club, and his Kickstarter has only been good for a couple hundred dollars a month. His website has been more or less abandoned and now serves mostly as a sad reminder of his inchoate dreams. The internet, ever willing to serve a stranger his supposed comeuppance, has declared the pursuit a failure. Even Dan himself is said to be contemplating publishing an epitaph for his efforts. The Dan Plan had become a cautionary tale.

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Young surgeons are presented with an enormously daunting task. We must, in spite of minimal previous experience and no underlying expertise, find a way to gain mastery over an enormously complex and highly technical set of tasks. It's a given that we'll sacrifice much to achieve our goal, but, at least at first, we often have no idea where we're going, much less how to get there. In short, we have a Dan Problem.

And, depressing websites and misplaced schadenfreude aside, a Dan Problem requires a Dan Plan. At their essence, Dan's story and the story most young surgeons have both start with the same simple premise: the more you practice something, the better you get. We've known this empirically for decades and we've known it intuitively since well before we convinced ourselves that knocking a patient out and cutting into his or her body might actually be lifesaving. Differences in the outcomes achieved by 2 surgeons can often largely be explained by how frequently they perform the procedure.1

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